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Together Learning Choices (TLC)

Intervention Description

Target Population
HIV-positive adolescent and young adult clinic patients

Goals of Intervention

Enhance health behaviors

Increase condom use

Eliminate or reduce unprotected sex or refuse to have unsafe sex

Eliminate or reduce drug and alcohol use

Brief Description

TLC (Together Learning Choices, previously referred to as Teens Linked to Care)is a small-group intervention designed for youth and young adults living with HIV. TLC consists of 2 modules: Stay Healthy and Act Safe. The Stay Healthy module consists of 12 sessions to promote positive health behaviors. Intervention sessions are focused on coping with learning one’s seropositive status, addressing issues of disclosure, and helping youth to implement new daily routines to stay healthy and actively participate in health care decisions. The Act Safe moduleconsists of 11 sessions to increase self-protection and other-protection motivation to change behavior and to reduce substance use and unprotected sex acts. HIV-positive youth identify their risk behavior triggers and modify their patterns of substance use as well as increase self-efficacy of condom use and negotiation skills. The modules are delivered in sequence by male and female facilitators to mixed gender groups of HIV-positive youth. A feeling thermometer is used in each session to assist youth in identifying and controlling negative emotional states. Group discussions, role-play, video, exercises, and goal setting encourage the ability to effectively reach goals, solve problems, and effectively respond to stressful situations.

Eligibility Criteria
HIV-positive youth were eligible if they were between 13 and 24 years old and received care at the participating clinical care sites. Parental consent was obtained for youth under age 18.

Comparison GroupYouth in the control group received standard care at the adolescent clinical care sites and were provided the intervention at the study’s conclusion.

Relevant Outcomes Measured and Follow-up TimeSex behaviors during past 3 months (including overall number of partners, not having sex, condom use, unprotected sex, and substance use during sex) were measured at 15 months after baseline, which translate to 3 months after completion of the Act Safe module.

The TLC participants reported significantly lower percentages of unprotected vaginal and anal sex acts with HIV-negative partners than the control group (p < .05) at 3 months after Act Safe module.

Considerations

This intervention fails to meet the best-evidence criteria due to small analytical sample sizes and low retention rates.

TLC was developed as a 3-module intervention. Module 3 (Being Together) consists of 8 sessions (2 hours each over a 3 month period) focusing on improving quality of life. No published report has evaluated the intervention effects of all three modules on HIV risk behaviors. Therefore, module 3 is not presented here.

A substantial number of participants were not eligible for participation in the Act Safe module because the funding period was ending before their follow-up would have been completed. It does not appear that this logistical issue would affect the interpretation of the findings, however the analyses are based on small sample sizes.

The original research targeted teens and youth (ages 13 to 24), however, the intervention package has been expanded to target young people (up to 29 years old).